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PSORIASIS
- inflamatory dermatosis of unknown origin
- there are dry, patches of varions sizes covered by silvery white or graysh white scales
- the lesions are present on the vulva, the scalp, nails, the extensor surface of the limbs,
and the sacral area
- diagnostis: clinical and biopsy
- treatament: topical use of corticosteroides
SEBORRHEIC DERMATITIS
- Is a red rash appearing in areas of skin where there is a high concentration of sebeaceous
glands
- Lesions can ivolve the scalp (“dandruff” term is used), areas behind the ears, between the
scapula, crural folds, perianal area, labia majora, mons and, intertriginous areas
- If vulva is affected there is severe itching, with the secondary excoration and infection
- Treatment:
Tranquilizers
Good hygiene
Topical steroid
Infection treatment with antibiotics if neccessary
NEURODERMATITIS
- includes atopic dermatitis and lichen simplex chronicus
- there is inflamation, excoriation, lichenifications, hyperpigmentation or lack of
pigmentation, hyperkeratosis – confusion with other dystrophies
- treatment:
tranquilizers
antihistamines
sedatives
of 1% triamcinolon ointment
LIPOMA
- a benign tumor that arrises from the fatty tissue of the labia majora or mons veneris
- is painless
- the size is 10–12 cm to the gigantic zize (in this situation the mass acquires a pedicle and
hangs from the groin or vulva as a pendulum)
- histologically: normal fat tissue with a connective tissue framework and capsule:
liposarcoma is extremely rare
- treatment: excision
FIBROMA
- a firm nodule on the labia majora which can grow and develop a pedicle
- the histological aspect is of any dermatofibroma
- treatment=excision
HIDRADENOMA
- is a beningn, slow – growing sweat gland tumor, whose histology similates that of an
adenocarcinoma
- treatment: excision and biopsy
MALIGNANT NEOPLASMS
- carcinoma of the labia majora, minora and vestibule – more common
- rare: clitoris, adenocarcinoma of Bartholin`s gland, adenocarcinoma of sweat glands,
sarcomas, malignant melanomas, teratomas and Paget`s disease
Routes of spread:
- direct extension – which involves vagina, urethra, perineum
- lymphatic embolization of regional lymph nodes:
ingninal-femoral nodes (Cloquet node)
pelvic nodes – external iliac group
- hematogenous spread to distant sites, including the lungs, liver and bones
Treatment:
Surgery: radical vulvectomy with bilateral lymphadenectomy ingninal-femoral in early
stages; pelvic lymphadenectomy is reseved for positive groin nodes, unless the primary tumor
involves the clitoris or Bartholin gland.
Complications of radical vulvectomy:
- immediate:
a) Schock – the pacient is old, the operation is long
b) Thrombosis and pulmonary embolism (risk for elderly pacients in pelvic surgery)
- later:
- chronic oedema is likely if there has been any thrombosis
- coitus should be possible after the operation, but removal of the clitoris ends all erotic
sensation: the patients must be aware about this risk before the operation.
Prognosis after radical vulvectomy:
- pacient`s age (elderly people)
- GRADDING
G1 – well differentiated
G2 – moderate differentiated
G3 – nondiferentiated
- lymphatic nodes:
50% of patients the inguino-femoral nodes are involved
15% lateral pelvic nodes
5 year survival rate:
• 40% when the superficial nodes are involved
• 20% when the pelvic nodes are involved
RADIOTHERAPY:
- it is not a treatment of choise
- is used for old patients and for relatively young patients (fifty years old) like an
alternative to the vulvectomy operation (a mutilating one)
- patients with 2 or more positive groin nodes
- radiation therapy consists of 4500-5000 cGy to the midplane of the pelvis at a rate of
180-200cGy per day
Indications of radiotherapy:
1. properatively in patients with advanced disease
2. postoperatively, to treat the pelvic nodes and groin of patients with two or more positive
groin nodes
3. postoperatively to help prevent local recurrences
4. as primary therapy for patient with small primary tumors in young and middle-aged
women, in order to ovoid a vulvectomy.
CHEMOTAERAPY:
Cisplatin and 5 fluorouracil, preoperatively associated with radioterapy for pacients with
advanced vulvar cancer who would otherwise require pelvic exenteration
PAGET`S DISEASE of the vulva
Is an intraepithelial carcinoma which may progress to invasive carcinoma and lymph
nodes metastasis.
Treatment: excision and for invasive disease radical vulvectomy and bilateral
lymphadenectomy.
Paget`s cells: are large, cells, lacking prickles and are surrounded by clear spaces,
cytoplasm is light and the nuclei are large, round and pale.